Quotes from Sherwin B. Nuland

The greatest dignity to be found in death is the dignity of the life that preceded it. This is a form of hope we all can achieve… the hope that resides in the meaning of what our lives have been.

So it was like the old scenario that so often throws a shadow over the last days of people with cancer: we knew—she knew—we knew she knew—she knew we knew—and none of us would talk about it when we were all together.

Carolyn had told me that while he was still able, Bob had arranged to have his favorite words from his favorite work of Dickens inscribed on his grave marker, but still I was unprepared for their effect when actually seen. Engraved across the granite face of the footstone was the epitaph by which Bob DeMatteis had chosen to be remembered: "And it was always said of him that he knew how to keep Christmas well.

The virus has robbed them of their youth, and it is about to rob them of the rest of their

reasons that one generation must give way to the next, as made clear in another of the letters Jefferson wrote to the equally venerable John Adams near the end of his life: "There is a ripeness of time for death, regarding others as well as ourselves, when it is reasonable we should drop off, and make room for another growth. When we have lived our generation out, we should not wish to encroach on another.

Poets, essayists, chroniclers, wags, and wise men write often about death ut have rarely seen it. Physicians and nurses, who see it often, rarely write about it.

The patient dies alone among strangers: well-meaning, empathetic, determinedly committed to sustaining his life - but strangers nonetheless.

Unless we are aware that we are dying and so far as possible know the conditions of our death, we cannot share any sort of final consummation with those who love us. Without this consummation, no matter their presence at the hour of passing, we will remain

unattended and isolated. For it is the promise of spiritual companionship near the end that gives us hope, much more than does the mere offsetting of the fear of being physically without anyone.

The difference between CVA as a terminal event and CVA as a cause of death is the difference between a worldview that recognizes the inexorable tide of natural history and a worldview that believes it is within the province of science to wrestle against those forces that stabilize our environment and our very civilization.

Though everyone may yearn for a tranquil death, the basic instinct to stay alive is a far more powerful force

Far from being irreplaceable, we should be replaced. Fantasies of staying the hand of mortality are incompatible with the best interests of our species and the continuity of humankind's progress. More directly, they are incompatible with the best interests of our very own children. Tennyson says it clearly: "Old men must die; or the world would grow moldy, would only breed the past again.

Whatever mystery attaches to such a death is imposed on it by those who live. It is a tribute to the human spirit that the life preceding triumphs over the ugly events that most of us will experience as we die, or as we move toward our last moments.

Today the law defines death, with appropriate blurriness, as the cessation of brain function. Though the heart may still throb and the unknowing bone marrow create new cells, no man's history can outlive his brain.

if peace and dignity are what we delude ourselves to expect, most of us will die wondering what we, or our doctors, have done wrong.

Whether the result of wear, tear, and exhaustion of resources or whether genetically programmed, all life has a finite span and each species has its own particular longevity. For human beings, this would appear to be approximately 100 to 110 years. This means that even were it possible to prevent or cure every disease that carries people off before the ravages of senescence do, virtually no one would live beyond a century or a bit more.

Persistence can only break the hearts of those we love and of ourselves as well, not to mention the purse of society that should be spent for the care of others who have not yet lived their allotted time.

Cancer cells are fixed at an age where they are still too young to have learned the rules of the society in which they live. As with so many immature individuals of all living kinds, everything they do is excessive and uncoordinated with the needs or constraints of their neighbors… they are reproductive but not productive.

No matter the technological sophistication of ultramodern molecular research, and no matter the increasingly abstruse terminology of its current literature, the circle of knowledge always returns to its starting point: In order to live, man must have air.

Beyond the curiosity and the problem-solving challenge fundamental to good research, I believe that the fantasy of controlling nature lies at the very basis of modern science.

The ultimate aim of the scientist is not only knowledge for the sake of knowledge, but knowledge with the aim of overcoming that in our environment which he views as hostile. None of the acts of nature (or Nature) is more hostile than death.

Nature will always win in the end, as it must if our species is to survive.

Perhaps the mere existence of things undone should be a sort of satisfaction in itself, though the idea would appear to be paradoxical. Only one who is long since dead while still seemingly alive does not have many "promises to keep, and miles to go before I sleep," and that state of inertness is not to be desired. To the wise advice that we live every day as though it will be our last, we do well to add the admonition to live every day as though we will be on this earth forever.

Since human beings first began to write, they have recorded their wish for an idealized ending some call the "good death," as if any of us can ever be sure of it or have any reason to expect it. There are pitfalls of decision-making to be sidestepped and varieties of hope to seek, but beyond that we must forgive ourselves when we cannot achieve some preconceived image of dying right.